A detailed history and physical examination were performed. The pertinent findings from the history included a compression fracture at L3 two years prior which had prompted a bone mineral density assessment.
The patient had been classified as osteopenic based on findings from a DEXA scan. The patient had been diagnosed with chronic obstructive airway disease (COAD), asthma, Raynaud’s disease, scleroderma and systemic lupus erythematosus (SLE), temporal lobe epilepsy and varicose veins in the pelvis. Significant degenerative change in the mid-lumbar spine had caused the patient several bouts of radiculopathy and lower limb neuropathy for which she had received previous facet injections and radio-ablation therapy. The patient denied any family history of scoliosis and was not aware of the presence of any spinal deformity when she was younger.
The patient had been fitted with a pacemaker at age 31. The referral letter sent by the patient’s GP listed 21 different prescription medications. The patient stated that one or more of these medications was causing her to be chronically constipated for the past four years. The patient also reported that she was a smoker.
The physical examination revealed anterior sagittal balance and right coronal imbalance in the postural assessment. There was an increased waist curve on the right, decreased lumbar lordosis and evidence of spinal curvature in the lumbar spine (Figure 1).
Physical examination revealed a generalized decrease in the lumbar range of motion with left lumbar lateral flexion markedly reduced. The Adams forward bend test produced humping in the left paraspinal soft tissues. There was no evidence of pelvic, sacral, or lower limb deformity. The patient’s neurological exam was unremarkable.
The patient had brought several forms of diagnostic imaging to the initial consultation. Plain films taken 10 months prior portrayed a 38° (Cobb) left lumbar scoliosis (Apex L2). Laterolisthesis was noted at L3/4 and significant spondylosis from L2-L5 (Figure 2).
The most recent films indicated that the patient’s scoliosis had progressed, now measuring 51° (Cobb). Computed tomography confirmed the findings from the x-ray and highlighted vacuum phenomena at L2/3 and L4/5 intervertebral disc levels.
The patient was diagnosed with a de novo degenerative lumbar scoliosis.